Costs Related to Entering NP Practice
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC, FNAP
I know that once I complete my NP program there are several additional steps I must take prior to entering practice, such as obtaining national certification, state licensure, and malpractice coverage.
What are the fees associated with each?
As you complete your nurse practitioner education and look forward to entering advanced practice nursing, you should be aware of the various fees and expenses you will incur prior to entering practice. These include fees for your state license application, national certification, Drug Enforcement Agency registration number, and malpractice insurance. Individually, each fee or cost is small in comparison to the overall cost of your education. However, covering these costs in a relatively short amount of time shortly after graduation takes planning and preparation. Here are the fees you should be ready to pay as you take your next steps toward NP practice.
In nearly all states, you must achieve national certification in order to obtain your state NP license. Furthermore, all third-party insurers and most employers require NPs to be certified; therefore, you essentially cannot get hired without being certified even in the non-certification-requiring states. The agencies that offer NP certification via computer-based testing, along with the exam fees they charge, are listed here:
- American Academy of Nurse Practitioners Certification Board (AANPCB)
Certifications: Family NP, Adult-Gerontology Primary Care NP, Emergency NP
Costs: AANP members $240, nonmembers $315; paper application fee an additional $50
- American Association of Critical-Care Nurses (AACN)
Certifications: Adult-Gerontology Acute Care NP
Costs: AACN member $260, nonmember $370,
- American Nurses Credentialing Center (ANCC)
Certifications: Family NP, Adult-Gerontology Primary Care NP, Psychiatric-Mental Health NP, and Adult-Gerontology Acute Care NP
Costs: American Nursing Association members $295,
AANP members $340, AANP student members
$290, nonmembers $395
- National Certification Corporation (NCC)
Certifications: Neonatal NP and Women’s Health Care NP
Care Nurse Practitioner $325
- Pediatric Nursing Certification Board (PNCB)
Certifications: Pediatric NP Primary Care and
Pediatric NP Acute Care
CERTIFICATION REVIEW COURSE
National certification is an important and, in most states, essential step to becoming a practicing NP. As noted, most employers and state boards of nursing require NPs to obtain national certification. Given the importance of passing the certification exam, certification candidates should consider attending a certification preparation course when preparing to take the exam. Candidates who do not pass on the first try must pay a fee to retake the exam. For example, the fee to retake the AANPCB exam is $240 for AANP members and $315 for nonmembers.
Fitzgerald’s NP Certification Exam Review is available for all tracks and exams in whatever format suits you best: online, live, livestream, or recorded and includes the Fitzgerald Pass Guarantee. Fitzgerald also offers convenient packages to help you get more value from your investment for Family, Adult-Gerontology Primary Care, Adult-Gerontology Acute Care, and Psychiatric-Mental Health prep.
AANP AND STATE NP ASSOCIATION MEMBERSHIP
While not a requirement to enter practice, NPs have a professional responsibility to join the American Association of Nurse Practitioners (AANP) and their state NP association and to keep these memberships current and ongoing. Unfortunately, of the approximately 211,000 NPs in the United States, only 118,000 are AANP members, and most state NP associations have only 10% to 20% of their state’s NPs as members. All of these organizations work to protect and further the role of NPs through legislation and education, which is a benefit to all NPs.
AANP membership provides many benefits, including financial benefits such as special member rates on professional liability insurance, discounted registration fees for the AANP National Conference, and discounts on AANPBC and ANCC NP certification exams. The membership fee is $55 for Student members, $95 for Career Starter members (ie, newly graduated NPs), and $150 for NP members. Visit AANP for more details.
STATE LICENSE FEES
Before you can practice as an NP, you must apply for and receive a license from the board of nursing in the state in which you will practice. The requirements for NP licensure, and the necessary applications and fees, differ from state to state. In general, however, the applications fees range between $100 and $300. In many states, the state NP licensure application also includes a prescriptive authority application fee. For example, in Oregon the initial advanced practice licensure fee is $225, which comprises a $150 application fee and a $75 prescriptive authority fee. To determine the exact fees and requirements of the state in which you plan to practice, visit the National Council of State Boards of Nursing.
DEA REGISTRATION NUMBER FEE
NPs have the authority to prescribe controlled substances in all states except Florida. In order to prescribe controlled substances, NPs must obtain a federal Drug Enforcement Agency (DEA) registration number. The DEA number fee is $888 for 3 years. Note that employers will often pay the fee for initial DEA registration or DEA renewal if you negotiate this in advance. Access the registration form.
Keep in mind, however, that the requirements NPs must meet to obtain a DEA number also vary from state to state; before you apply, you should check with the state board of nursing to determine the specific requirements in the state where you will practice.
Experts recommend getting as much malpractice coverage as you can afford, but getting at least $1 million per occurrence.1 NPs will need to purchase malpractice insurance if their employer does not cover them under their policy and should consider purchasing their own policy if an employer’s policy has limits below $1 million.1 One of the most compelling reasons to carry your own liability insurance is that it will get you additional legal counsel if you are sued. Premiums vary by area of certification, length of time in practice, the state in which you practice, and the liability limit you select, and generally range from approximately $650 to $1500 per year.
Knowing the additional costs you face after graduation is important, but it’s also a good idea to have an understanding of your projected income as an NP once you enter practice. According to the U.S. Bureau of Labor Statistics, the median annual salary for NPs in May 2020 was $111,680, with those in the 10th to the 25th percentiles earning a mean annual wage between $82,960 and $94,890, and those in the 75th to the 90th percentiles earning between $130,240 and $156,160.2 Salary varies considerably by state, with NPs practicing in states comprising the western third of the nation generally earning more than NPs in the Midwest and South. The states with the highest mean annual wages are California ($145,970), New Jersey ($130,890), Washington ($126,480), New York ($126,440), and Massachusetts ($107,230); those with the lowest mean annual wages are Tennessee ($99,370), Alabama ($99,790), Florida ($101,060), South Carolina ($101,190), and Kentucky ($102,460). For more state-by-state information about NP salaries, visit the Bureau of Labor Statistics.
1. Buppert C. Questions and answers on malpractice insurance for nurse practitioners. Medscape. http://www.medscape.com/viewarticle/520660. Accessed May 10, 2021.
2. U.S. Bureau of Labor Statistics. Occupational employment and wage statistics. Occupational Employment and Wages, May 2020. 29-1171 Nurse Practitioners. http://www.bls.gov/oes/current/oes291171.htm. Accessed May 7, 2021.